Management of a Patient Exposed to a Blister (Vesicant) Agent

Description

The topical blistering (vesicant) agents such as sulfur or nitrogen mustard are infrequently lethal but can cause significant morbidity that can persist for years. The lesions evolve over hours to days after the exposure. Early recognition and proper management can minimize long term sequelae.

Initial management consists of rapid decontamination:

(1) Remove all clothing and liberally wash the patient with water, soap and water, or a dilute hypochlorite (Clorox) solution.

(2) Pay particular attention to the mucosal surfaces, axilla and perineum. These areas tend to have more severe injury since they are moist and warm.

(3) Lavage the eyes with saline.

Exposure	Comment	Management
skin	skin blistering over several days; extensive disease similar to thermal burn but more transudative with less protein loss	fluid replacement but avoiding fluid overload; debridement and topical antibiotics if ulcerated; calamine or other lotions for erythema
eyes	lacrimation, conjunctivitis, photophobia, blepharospasm, eyelid edema, corneal burns	Vaseline or other topical therapy to eyelid margins to prevent fusion of the eyelids; cycloplegic-mydriatic agents to minimize synechiae; topical antibiotics
pain	may be severe	opioid analgesics
bone marrow suppression	leukopenia after several days; less often pancytopenia	granulocyte colony stimulating agents
respiratory tract	rhinorrhea, hoarseness, cough, bronchospasm, dyspnea, pseudo-membrane formation, bronchial plugging, airway obstruction	may require supplemental oxygen, insertion of an airway, mechanical ventilation
gastrointestinal tract	nausea, vomiting, diarrhea and bleeding after several days	anti-nausea agent
infection	usually in blistered areas or as bronchopneumonia	topical and systemic antibiotics

Causes of death:

(1) overwhelming infection

(2) respiratory complications

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Description

Specialty

ICD-10